进展性缺血性脑卒中危险因素及其预测价值研究

An investigation of risk factors in progressive ischemic stroke and their predictive value

目的 探讨进展性缺血性脑卒中的危险因素及其预测价值。方法 将本院在2013年10月-2014年10月期间收治的226例脑卒中患者按病情是否进展分为实验组（58例）与对照组（168例）;应用实验室和影像学检测D-二聚体、空腹血糖、颈动脉斑块等相关指标。结果 2组颈动脉斑块（χ2=20.345,P〈0.001）具有明显差异;且2组的入院时收缩压（t=6.389,P〈0.001）和SSS评分（t=11.800,P〈0.001）也均具有明显的差异,入院后血压降低（χ2=43.560,P〈0.001）也有明显差异。2组的D-二聚体（t=14.698,P〈0.001）、空腹血糖（t=7.043,P〈0.001）、同型半胱氨酸（t=25.902,P〈0.001）等因素的差异均具有统计学意义。作多因素Logistic回归分析表明,D-二聚体（χ2=22.918,P〈0.001）、空腹血糖（χ2=32.062,P〈0.001）、颈动脉斑块（χ2=16.792,P〈0.001）、入院后血压下降（χ2=38.270,P〈0.001）、糖尿病史（χ2=4.798,P=0.0285）均有统计学意义（P〈0.05）。结论 有糖尿病史的缺血性脑卒中患者若入院后其血压显著降低,且应用实验室检测静脉血中D-二聚体以及空腹血糖含量增加,或应用影像学检查颈动脉斑块时极大可能会恶化或使病情进行性加重;即这五个因素就是进展性缺血性脑卒中的危险因素。

Objective To explore risk factors in progressive ischemic stroke and theirs predictive value through research and analysis on patients data of this disease and their related indicators. Methods 226 stroke patients were admitted to hospital from October 2013 to October 2014, and divided into experimental group （58 cases） and control group （168 cases） according to the disease＇s progress. D-dimer, fasting blood glucose, carotid plaque and the other related indicators were detected in laboratory or by imaging, the obtained data was subjected to statistical tests, and the significant factors were tested by Logistic regression analysis to determine the risk factors. Results Carotid plaque, systolic blood pressure and SSS score on admission, and the decrease of blood pressure after admission in two groups had significant differences （χ2 = 20. 345, P〈0. 001 ; t = 6. 389, P〈0. 001 ; t = 11. 800, P〈0. 001; χ2= 43. 560, P〈0. 001, respectively） by statistical tests. D-dimer （t = 14. 698,P〈0. 001）, fasting blood glucose （t = 7. 043,P〈0. 001）, homocysteine （t = 25. 902,P〈0. 001） and other factors in the two groups were statistically significant. D-dimer （χ2 = 22. 918,P〈0. 001 ）, fasting blood glucose （χ2 = 32. 062,P〈0. 001）, carotid plaque （χ2= 16. 792,P〈0. 001 ）, the decrease of blood pressure af- ter admission （χ2 = 38. 270,P〈0. 001）, and the history of diabetes mellitus （χ2= 4. 798, P = 0. 0285） were statistically significant by Logistic regression analysis （P〈0. 05）. Conclusion Ischemic stroke may be aggra- vated when associated with diabetes （factor 1）, the significant decrease of blood pressure after admission（factor 2）, and the increase of D-dimer （factor 3） and fasting blood glucose （factor 4）, or carotid plaque （factor 5）. The above five factors may be the risk factors of progressive ischemic stroke.